3/5/2010
EATING DISORDERS
ANOREXIA NERVOSA BULIMIA NERVOSA
•Have a body weight that is 85% or less of that
expected of their age and height..
•Have experienced amenorrhea for at least 3
consecutive cycles..
•Have a preoccupation with food and food-related
activities..
•Clients with anorexia actually don’t lose their appetites., but
rather, they experience hunger but they are ignoring it for they
believe that whenever they start eating, they will never be able to
stop it anymore…Then they will become FAT..
Anorexia
-anorexia nervosa
• is a psychiatric illness that describes an eating
disorder characterized by extremely low body weight
and body image distortion with an obsessive fear of
gaining weight .
• Eating too little..
• Self starvation..
• It begins as early as 14-18 yrs of age..
• Most common among women than men..
ANOREXIA NERVOSA
• ETIOLOGY:
– Biological factors : Increased serotonin levels
– Socio-cultural factors: ideal woman
– Family factors: emotional restraint, enmeshed
relationships, rigidity in the organization of the
family, avoidance of conflict
– Cognitive and behavioral factors: reinforced idea
about rejecting food and losing weight
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ANOREXIA NERVOSA Food-related activities:

• PSYCHODYNAMICS
• Grocery shopping..
– Appetite is an expression of the libido
– Food and eating are symbols of nurturing and love • Collecting recipes or cookbooks..
– Anorectic reject nurturing. • Counting calories..
– An early history of sexual abuse • Creating fat-free meals..
– Regression to prepubertal state
• Cooking family meals..
– To reduce the control of overcontrolling maternal
figure
– An obsession with weight for fear of being out of
control

Unusual/ ritualistic food behaviors: ANOREXIA NERVOSA

• Refusing to eat around others.. • Amenorrhea
• Cutting food into minute pieces..
–Lack of nourishment slows the
• Not allowing their food to touch their lips..
functioning of pituitary glands.
…these behaviors increase their sense of –Fat level below 17%
control. They may perform excessive
exercising and other more.

ASSESSSMENT ANOREXIA NERVOSA

A- Amenorrhea
N- No other organic factor accounts for weight loss
O- Obviously thin but feels fat
R-Refusal to maintain body weight
E- Epigastric discomforts
X-Symptoms like hiding foods, collecting recipes
I- Intense fear of gaining weight
A- Always thinking about food
• Physiologic Changes
Constipation, hypotension, bradycardia and
hypothermia
dry skin, lanugo
dehydration leading to renal failure
prolonged amenorrhea: osteoporosis

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2 SUBGROUPS OF ANOREXIA What is binge eating?

• RESTRICTING SUBTYPE • BINGE EATING –
PURGING SUBTYPE
>dieting.. >vomiting..
>fasting.. >misuse of laxatives..
>excessive exercising.. >enemas..
>diuretics..

What is purging?.. Binge eating and purging

..the
compensatory • Frequently begins during or after dieting.
behavior • May eat low calorie foods.
designed to
eliminate food
• Restrictive eating effectively sets them up for
by means of the next episode of binging and purging, and
self- induced the cycle continues..
vomiting.

The long term studies of clients
with anorexia reveals 30% were
well, 30% were partially
improved, 30% were chronically
ill and 10% had died.
Bulimia
-bulimia nervosa
• Is an eating disorder characterized by recurrent
episodes of binge eating followed by
inappropriate compensatory behaviors to avoid
weight gain.
• Usually begins in late adolescents or late
adulthood :18/19 yrs is the typical age at onset.
… binging or purging episodes are often
precipitated by strong emotions and followed
by guilt, remorse or self-contempt.

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A person with bulimia..

• Usually is in the normal range of weight.
• Some are overweight or underweight.
• Has pathologic eating behavior hidden from
others.
• 10yrs after treatment, 30% continued to
engage such behavior 38% to 47% were fully
recovered but relapse may occur 3% or less
dies.
ETIOLOGY
• BIOLOGIC- familial psychiatric disorders
• DEVELOPMENTAL/ environmental - autonomy
and unique identity (self-environment)
• SOCIO-CULTURAL- things that being taught.
• COGNITIVE AND BEHAVIORAL- low self esteem
• PSYCHODYNAMIC- the feeling of ambivalence

ASSESSMENT Signs and symptoms

B- Binge eating
• Depressive and anxiety symptoms
U-Under strict dieting or vigorous exercise
• Lost of dental enamel
L-Lack of control over eating binges
• Menstrual irregularities
I-Induced vomiting
• Esophageal tears
M-Minimum of two binge-eating episode in a week
• Dependence on laxatives
for a period of three months
• Fluid and electrolyte abnormalities
I- Increased or persistent concern over body size
and shape
A- Abuse of laxatives or diuretics

Bulimia…..
Anorexia vs. Bulimia
Anorexia Bulimia
• Early onset
Later onset
• Very low weight
More normal weight

• Amenorrhea for some
Menstrual irregularities

patients but not amenorrhea

Fluid and electrolyte
• Hormonal imbalance
imbalance

Constipation if not using
• Constipation if not laxatives
using laxatives

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MANAGEMENT Nurse-Patient Relationship

• Convey warmth and sincerity.
• Psychotherapy • Listen empathically.
• Milieu • Be honest.
• Set appropriate behavioral limits.
• Cognitive behavioral • Assist patients in identifying their positive
therapy qualities.
• Collaborate with patients.
• psychopharmacology • Teach patient about their disorders.

Milieu Management Psychotherapeutic Management

• Provide an orientation to the setting to
prepare the patient for inpatient or outpatient
treatment so that fears will be reduced.
• Provide a warm, nurturing atmosphere.
• Closely observe patients.
• Encourage the patient to approach a team
member if feeling the need to purge.
• Involve the patient’s family in treatment,
when appropriate.
• COGNITIVE-BEHAVIORAL Therapy
• treatment depends on the condition of the
patient
• geared towards increasing self-esteem
• make them realize their present condition
• help patients reestablish appropriate eating
behavior

Psychopharmacology Binge-Eating Disorder

• Anxiolytics Warning Signs of Binge-
– In anorectics, for anxiety, depression, somatic Eating Disorder
disturbances, and other comorbid conditions • Frequently eats large
– In bulimics, for anxiety to reduce bingeing and purging amounts of food
• Olanzapine (Zyprexa) –atypical antipsychotic • Eats rapidly
– promote weight gain • Often eats alone
• SSRI –antidepressants • Expresses self-disgust
– In bulimics, reducing bingeing, purging, and after overeating
depression • Obesity

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Health Consequences of Binge-Eating Disorder
• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Gall bladder disease
• Heart disease
To ensure compliance for an increase
in weight program, an effective
nursing intervention is:
A.Explain to Rosa the details of
behavior modification
B. Leave Rosa after eating meals
C. Let Rosa got to the bathroom after
meals
D.Set limits on time allotted for meals
One psychological aspect of
bulimia is the belief that:
A.one’s self esteem is determined by
one’s body shape
B. bingeing is harmful to the body
C. purging will reduce caloric intake
D.aware that eating pattern is
abnormal
3/5/2010
Rosa, 17y/o college student, was
referred for weight loss of 48lbs.
Diagnosis: Anorexia Nervosa
Assessment data will most likely
reveal:
A. persistent eating for at least one month
B. recurrent episodes of binge eating
C. intense fear of becoming obese
D. awareness that eating pattern is
normal
To increase her self-esteem, an effective
nursing intervention is:
A.reinforce perfectionism
B.provide positive reinforcement
C.teach anger suppression
D.promote dependence
One of the most common
characteristic of person suffering from
Bulimia is Binge-eating or Bingeing.
This refers to:
A. Insatiable appetite
B. Eating unusually large amount of food
over a short period of time
C. Self-induced vomiting
D. Use of laxatives, diuretics & enemas to
compensate for calories consumed